Sharing the Secret

Introduction

Sharing the Secret was made as a television drama in
the United States in 2000 and first released in the UK on DVD in
2003. It received a Peabody
award in 2001 for the accuracy of its portrait of a
teenager in crisis. Directed by Katt Shea, with perceptive
performances from its cast, it explores the subject of bulimia
nervosa in a high achieving teenage girl, Beth, whose parents
divorced a few years earlier. Offering a wonderful platform for a
discussion about eating disorders in general, it could also be used
to explore the differential diagnoses that may be associated with
the symptom of binge eating. Of additional interest is the fact
that Beth’s mother, Dr Nina Moss, is a child psychologist who
treats children suffering from emotional difficulties as a result
of divorce but who is unable to detect the early signs of emotional
difficulty in her own daughter.

The Film

The film opens with teenager Beth having breakfast
in a restaurant with her father John, who is remarried and has a
young son. Beth excuses herself to go to the toilet, looking
tense and upset. We next see her in the flat, where she lives with
her mother Nina, as Beth is doing homework w ith a friend. Her
mother comes home hungry that evening and is unable to find a
portion of Chinese food that she had stored in the fridge. Beth
tells her that she had thrown it out because the smell made her
feel sick. Nina comments to Beth that she has grown ‘tall and
skinny’ and Beth replies that she likes looking that way. These
first few minutes set the scene for the story that unfolds,
introducing the suspicion of something secretive about Beth’s
behaviour concerning food and that she has a particularly acute
focus on her own body image.

Beth is a bright and able student who has a passion
for ballet. She is struggling to fit in with her peers, who are all
preoccupied to some extent with their body appearance and the world
of dating. At a friend’s party, Beth actively sabotages the
approaches of a boy and in the following scenes she is seen to
avoid eating, always giving a seemingly plausible reason for her
abstinence, until we are eventually shown her binging secretly on a
large amount of food before making herself vomit.

Her father wants to integrate Beth more fully into
his new family and invites her to stay over at his house for a
weekend, something that she has not done since his remarriage. In a
particularly poignant scene, during the first sleepover, her father
tells Beth that she is gorgeous and then says “I wish I’d frozen
you at 10, you’re growing up so fast”. Beth, clearly upset by this,
denies that she is growing up. In contrast, Beth’s mother does not
have a new partner but works long hours as a child psychologist.
She and Beth appear to have an overly close, loving relationship in
which Nina even shares certain details about her patients. Indeed,
Nina’s therapy sessions with one young girl, Rachel, are shown in
some detail. The film portrays Nina’s attempts to ‘give Rachel a
voice’, to express the difficult feelings she has in her father’s
newly blended family. This storyline contrasts brilliantly with
Beth’s reality in which her parents seem to have worked hard to
avoid any openly expressed negative emotions about their
separation, although animosity simmers just below the surface.
This, in turn, has left Beth trying hard to please them both with
her compliant behaviour and high academic achievements.

Beth’s secretive bulimic behaviour finally comes to
light as her physical health deteriorates and she collapses at
school. Forced into therapy by her mother, Beth initially rebels
but then begins to engage with the therapist, allowing her to
acknowledge her illness. It is only then that she asks for some
inpatient help, as she recognises the need to get some distance
from both her mother and her father. In a brilliant scene between
Beth and Nina, in which Nina describes the shame and guilt that she
is having to bear, Beth shouts out angrily “ It’s not about
you....it’s about me”. The film ends with Beth beginning to make
progress in the inpatient unit but with more still to achieve,
viewers must decide how they feel about her future.

Relevance to the field of Mental Health

As a clinical case study, Sharing the
Secret presents a very good portrait of bulimia nervosa and
provides an excellent presentation of some of the underlying
psychological issues that may play a part in the genesis of an
eating disorder in the teenage years. The film also offers an
opportunity for discussing the difficulties that may be encountered
in trying to engage sufferers in any form of psychological therapy.
Sharing the Secret could also be used for teaching
students about the wider effects that an eating disorder, in one
family member, can have on others in the family. In particular, it
explores the painful struggle of a mother who is forced to cope
with the guilt she feels about failing to recognise her own
daughter’s eating disorder.

There is a useful, detailed discussion on the topic
of bulimia and binge eating in an article by Zaffra Cooper and
Christopher G. Fairburn, in Advances in Psychiatric Treatment
(2009) 15: 129-136 entitled Management of bulimia nervosa and
other binge eating problems (abstract).
This article was a revision of a paper by Christopher G. Fairburn
with the same title, published in Advances in
Psychiatric Treatment (1997), vol. 3, pp. 2-8, now
freely available in its entirety. Beth clearly presents the three
cardinal features required for the diagnosis of bulimia nervosa;
frequent binges of large amounts of food; the use of vomiting,
fasting and or exercise to control shape and weight, and, lastly,
an extreme focus and concern about weight and body shape, indeed a
fear of being fat, bound up closely with a low self-worth. All of
this occurs without excessive weight loss.

CBT for the treatment of bulimia nervosa has a good
evidence base and there is an interesting article discussing the
use of CBT for a variety of conditions when working with young
people and their families, entitled Cognitive-behavioural
therapy with children, young people and families: from individual
to systemic therapy in Advances in Psychiatric Treatment
(2010) 16: 23-36 (abstract)
written by consultant psychiatrist Nicky Dummett.

With its excellent portrait of an eating disorder
in a teenager, I would definitely recommend Sharing the
Secret to anyone interested in working in the field of child
and adolescent psychiatry regardless of their discipline. This film
may also be of interest to sufferers and their families.